Provider Demographics
NPI:1841376878
Name:ROSSI, LAWRENCE J JR (MD)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:J
Last Name:ROSSI
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9030
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-9030
Mailing Address - Country:US
Mailing Address - Phone:847-495-1617
Mailing Address - Fax:847-537-4866
Practice Address - Street 1:107 TREMONT ST
Practice Address - Street 2:BOX 267
Practice Address - City:HOPEDALE
Practice Address - State:IL
Practice Address - Zip Code:61747-0267
Practice Address - Country:US
Practice Address - Phone:309-449-3321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036057828207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL050036797OtherRAILROAD MEDICARE
IL036057828 5Medicaid
IL09019736OtherBLUE SHIELD
IL09019736OtherBLUE SHIELD
ILL69913Medicare ID - Type Unspecified